The White Coat hierarchy

When I jokingly posted about the White Coat effect several weeks ago, I got a number of comments from other medical students about how their hospitals give out white coats (long and short) to everyone from physician assistants to nurses to dental students. So I started thinking about all of the white coat-clad people that I’ve seen wandering the halls of my own university hospital system, and there are actually quite a few. More, even, than I had the patience to include in my comic above.

White coats have long been a symbol of the medical profession, and surveys indicate that “easy recognition by patients and colleagues” is a chief reason that doctors and medical students choose to wear white coats. One thing that I don’t think I ever thought about or realized before I started medical school is that medicine is as much about putting on a show as it is about interpreting test results and handing out prescriptions. We perform mysterious physical exam maneuvers, speak using an unnecessarily complicated vocabulary, make small talk, smile, and yes, wear white coats, all (at least in part) to convince our patients (and sometimes our colleagues and superiors) of how smart or competent or compassionate or kind we are. We need to be able to make our patients trust us as much as we need to to actually be able to take care of them, and wearing white coats has traditionally been part of that equation. In fact, studies have shown that patients are more likely to trust physicians who wear white coats.

Of course, if the white coat inspires confidence, trust, and respect among patients, it’s no wonder that every health care professional under the sun (or anyone with any connection at all to health care) would want to wear one. But the white coat is as much a symbol of hierarchy as it is a symbol of competence. At most institutions, medical students like myself are required to wear short hip-length white coats, while residents and attendings wear long knee-length white coats. Some institutions have gone so far as to introduce different white coat styles/identifiers for med students, interns, residents, chief residents, attendings, and so on. As other health care professionals join the fray, the need to distinguish them from one another and from physicians at all levels of training, sometimes results in even more elaborate variations.

A friend of mine suggested that all the doctors and medical students should start wearing capes, just to see how quickly it would catch on in the rest of the hospital.

6 thoughts on “The White Coat hierarchy

  1. I actually thought that all white coats were the same, and that professionals wore them to protect themselves from yucky things that may come from a patient’s body, the same reason chemists and biologists wear white coats in lab.

    I hope that I’m not a killjoy by saying this, but your comment about capes just reminded me of the superhero-outfit-maker’s comment about them from the Incredibles for some, odd reason because of all the wheels and carts that appear out of nowhere in hospitals. (Or is that just in the movies?)

    • Unlike lab coats, the physician’s white coat was conceived as a performance piece to begin with. My understanding is that doctors borrowed the white coat from scientists in the 19th century in order to identify themselves as “scientists” with a scientific basis for their practice (and in order to distinguish themselves from “quacks”). It’s rather ironic, but most doctors will actually take off their white coats as they’re about to do a procedure in order to keep their white coats clean. Most doctors in procedure-heavy specialties will wear scrubs for the purpose of protecting themselves from “yucky stuff,” which are usually provided by and laundered by the hospital for free.

  2. I didn’t realize PTs wore white coats. All the PTs I’ve ever shadowed simply wore scrubs (inpatient) or polo+khakis (outpatient). I thought the idea of nurses, PAs, and even pharmacists wearing white coats was kind of unnecessary.

    • I think it’s variable between different institutions. The PTs and pharmacists at my university hospital wear white coats, but the nurses just wear scrubs. Our PAs and NPs also wear white coats, but they also often function as interns on the team, so this makes more sense (due to the new intern work hour rules, many of them have been hired to fill in the gaps).

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